To think GPs should be able to check medication availability

[jeaux90]

I'm absolutely fed up of ordering medication to turn up at the pharmacy to be told the manufacturer is out of stock.

If they have access to the system why isn't the GP checking this and prescribing the alternative? Surely machine learning/AI would help here or are the systems not integrated?

I mean in the whole era of technical progression why are we running between Boots and the GP to get things re-prescribed?

For context this has happened with my HRT, my DD14 ADHD medication, antibiotics etc etc over the last three months.

AIBU to expect an integrated supply approach to prescriptions?

At the moment I put eye drops on a separate script so the patient can shop around as there is a problem with certain pharmacies not being able to get them. There are so many things unavailable we can't keep up with the information we are given. The patient can get their usual in stock meds from their usual pharmacy.

What's baffling is that it used to be.

At university in 2007, I could choose my appointment online and manage prescriptions. The information was automatically shared with my home GP for summer holidays. In 2010, new city, emergency appointment overnight, all the details shared with the GP the next morning. All of them using those flash boards for appointments in the waiting room.

Fast forward to now, and I've had to use two apps and letters to manage my prenatal care. And still had to correct people all the time on my records. And their systems are so bad they failed to flag a really simple screening test resulting in my developing pre-eclampsia.

No you are overcomplicating it by adding extra messages. We send one when it is complete and ready to collect. If someone comes before they get the text they know their prescription isn't ready - this may be because we haven't received it from the GP or because we are waiting for an item but they know no text = no prescription.

The text system is an automated message saying "Your Rx is ready to collect from X pharmacy" via our dispensing system - we don't send out individual texts, it is a generic "your parcel is ready to collect" message that requires 30 seconds of time to send. Individual messages require more admin time we just don't have.

Mrs Jones' prescription arrives with us on Monday morning for Levothyroxine 100mcg, Amitryptillin 10mg, Levothyroxine 25mcg, Adcal ... We have them all except Levo 25 when we dispense it Monday lunchtime. We look at the suppliers website and see it's in stock so order it and it will arrive Tuesday morning.

We wait till Tuesday for the Levo to arrive, when it does we add it to the bag we have already made up and send a text saying it's ready for collection.

Mrs Jones knows we will text when it's all ready so knows to come when she has the text on Tuesday to collect everything and if she comes and asks about the prescription on Monday then at least one item is on order and she will have to make a second trip, but that is entirely her own decision.

Sometimes we can't order something or it's an item that has been out of stock for a while, in which case we will send the collection text and inform the customer when they come in that X is out of stock and has been for days/weeks (if our suppliers don't have a time frame for it to be back in stock then we can't just guess) or try to get hold of the GP to prescribe the alternative before they come in but again this is all time and admin systems we don't have for every single prescription, especially when the Levo is only out of stock with us for less than 12hrs ... If Mrs Jones needs the Levo today because she has run out and not put her repeat request in to the GP with enough time then she needs to be the one to do the admin to find somewhere that has it in stock.

I’m sorry but I kept getting texts to pick up prescriptions and it was every two weeks for bits and pieces because the pharmacy took it upon itself to order at random. If they had told me what was for collection Incould have sorted it out without the 45 minute round trip every other week.

the pharmacy blamed the GP, the GP blamed the pharmacy. I spoke to the prescription desk, the practice pharmacy, the practice manager and eventually made a GP appt. It resolved when I changed the nominated pharmacy which had changed hands to —an amateurish sheister—.

Now I open the package in the pharmacy and check every item before I leave. I was prescribed more than 550 Amitryptillin between Jan and April. I take one a day. It makes a mockery of 56 day prescribing. Presumably nobody checks what they sign. It’s a shambles.

Agree with this! The list of unavailable meds is so bloody long there isn’t a hope of being able to remember it all.
Most of us will do what we can by putting ‘hard to find’ drugs on separate scripts that can be cashed in at any pharmacy, warn the patient that this may be an effort to locate and prescribe alternatives if they exist.
Brexit, increased awareness of menopause and HRT options, and ADHD diagnosis going up have all massively contributed and demand hadn’t bee anticipated by manufacturers.
It’s frustrating for us too.

Totally agree. I was prescribed a cream for my daughter, age 2. Out of stock everywhere. Pharmacist helpfully tells me there is an ointment with equivalent ingredients/use that they could give me at their discretion. Me: "so can you use that discretion and give me the ointment?". Them: "no". Cue more traipsing around until I find a pharmacy willing to give me the ointment (only after I pleaded that I'm not going to be abusing the ointment and the alternative option is to leave a 2 year old in discomfort with a skin condition which isn't going to resolve itself. So frustrating.

It also really varies between pharmacy. I find the independent one is much better at having stock.

I can't comment on improving pharmacies.

However in terms of adhd meds - get the GP to prescribe a variety of sizes. So for example for my DD for her thyroid prescription (made up
Example she takes much more than this) he prescribed 100mg, two x 50mg and 4 x 25mg.

This meant that she was usually able to get at least something and didn't run out (again, only a month at time).

The pharmacies were usually more prepared to swop dosages around as well because they could see that 100, 50 and 25 were in the prescription,

Also, and more usefully, boots seem to have an integrated system and can tell you where there is a boots pharmacy with some of the medication you want.

@RuhRohRaggy

That is horrible.

This happened when i picked up DHs script on Friday. No Zapain so they replaced it with a generic

@melj1213 I'm not asking it to be a government controlled monopoly.

I'm asking for more intelligence and date integration.

It really isn't impossible.

I love the 'it really isn't that hard' mentality.

Easiest £2/3/400m you'll ever make.

Who is going to mandate this though? If you think the NHS has any power you’re sadly mistaken.

Again @melj1213 this isn't about how the pharmacy process works it's the lack of intelligence in the GP hands.

Honestly it really isn't that hard.
I've been working in software and integration for years, I see how machine learning and AI is applied in different industries, how automated workflows work.

How they can make the lives of both the employees and users better.

It just feels like no one can be bothered to solve the problem.

I feel so bad for the elderly chasing down what they need it's bloody heartbreaking. I see pharmacists exhausted. GPs overworked. People like me not getting the medication on time because I turn up to a bullshit text.

We could alleviate some of this.
The government, NHS etc just don't seem to have to will to do it.

Right, back to ironing school shirts for my DD14 who will have to go to school tomorrow without her ADHD medication.

Chemists are like the Post Office, outdated slow and need a bomb up their arses to get into the 21st century. I'm not sure chemists have even heard of bar codes but surely they could be used to assist in delivering some kind of organised service

Totally agree.

My mum has difficulty getting certain eye drops from her pharmacy. Yet I can order them on Amazon for her just fine. So it's not that they are unavailable, just that the pharmacy can't be bothered to find out where there might be some stock.

I don't necessarily expect a GP to know about every medication, but I do expect a pharmacist to check availability locally if they don't have it themselves.

@IrresponsiblyCertainAboutSexualDimorphism

Mandate what? This isn't about a change politically, not about enforced organisational changes, it's about data and systems which is in the hands of NHS digital. The funding for which is in the hands of the government.

I know there is a big overhaul going on about IT etc but I can guarantee you it won't fix anything we talked about on this thread.

Well they had a lot of power to contribute to decisions as to whether people could see their own families so nobody will buy that excuse any more

Its almost like pharmacies are private companies with set supplier contracts who can't just go and buy the items from any random company who has stock when their suppliers have none.

That's like saying "Asda didn't have any milk and said they were waiting for a delivery tomorrow but Tesco down the road had loads so I don't know why Asda can't buy the milk from Tesco until they can get their delivery"

Different companies. Different suppliers.

Independent pharmacies have more leeway as they can often negotiate differently to chain pharmacies who are locked into contracts with specific suppliers, but where independents have more flexibility with supply chains often have the benefit of scale - because they buy higher quantities then they can often negotiate better deals/prices than independents.

GP’s haven’t got time, but you can check yourself on the Boots website,it will tell you where there is stock, the only issue is, you can’t reserve, so if a prescription is dispensed the stock could be taken. It have always worked well for me.

But the point is that GPs cannot have access to this information because the information is held by multiple private companies who happen to all have contracts with the NHS.

GPs are private businesses. Pharmacies are private businesses. They both have contracts with the NHS but are not controlled by the NHS.

What you want is for GPs to have access to every single pharmacy - from the multinational chains like Wells, Boots, Lloyds etc to the single independent pharmacies - so that they can only prescribe what is in stock. This is impossible as pharmacies cannot be compelled to make their inventories available to any and all GP/Health clinic/hospital/dentist/supplemental subscriber/private doctor that wants it.

Most shortages are transient due to stock holding not being in the right place when it's needed but it can be reallocated within 24hrs, to signpost those shortages would take more admin and time than it is worth.

Major shortages where the issue is the manufacturer/suppliers and not individual pharmacies are already notified by the SSPs set out by the Health Board

So what exactly do you want as the system you are proposing would work if the NHS, GPs and pharmacies were all one entity but they are not, have never been and will never be and therefore your proposal is impossible to implement

GPs are only just starting to link with hospitals so I think linking with pharmacies is a long way off yet.

The information is not in the hands of the NHS though! This is the point you are not taking on board.

I work in a pharmacy within a supermarket. The pharmacy is owned by the supermarket. We have a contract with the NHS to provide certain services bit we can also do services outside of the NHS because we don't have exclusivity to only work with the NHS as they are a client who uses our service not our employer.

The NHS does not have any information on what stock we hold on a daily basis, they cannot control which suppliers we choose to use, or what dispensing/sales we make outside of our NHS contract as we are not obliged to give them that information and they can't compel us to hand that information over.

GPs are not "the NHS".
Pharmacies are not "the NHS".

Why do you keep going on about the NHS having the ability to make this (impossible) system happen if they just applied themselves better?

Yes it would be nice wouldn’t it. If it was possible. Which it isn’t. What would be even nicer is if there weren’t these ridiculous shortages in the first place I’ve never known anything like it. GP’s also have plenty more things to be doing than redoing prescriptions for the entire days worth of patients!

It wouldn't matter anyway. We send a note to local GPs all the time to tell them which meds are out of stock yet they still send a script for those meds all the time. Which messes up our system as we have a tonne of scripts not dispensed on the system which we get penalised for.

Even if they were all one entity, another GP could prescribe at the same time or a patient go to a different pharmacy and the new system still wouldn't work.